Laparoscopic gastric pouch resection and esophago-jejunostomy after gastric bypass: indications and outcomes

Marginal ulcers (MUs) are a well- recognized complication after Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB). When medical therapy fails or complications occur, revisional surgery may become necessary. In addition, revisional surgery may be required in case of other gastric pouch pathologies, such as gastric pouch neoplasms. Laparoscopic gastric pouch resection with esophago-jejunostomy (LGPREJ) represents a feasible salvage option. This study aimed to evaluate LGPREJ as a salvage surgical option after pouch complications following gastric bypass surgery. We performed a retrospective analysis of all adults undergoing LGPREJ at a high‑volume Swiss bariatric center between January 2018 and December 2023. Patients had prior RYGB or OAGB and at least two years of follow-up. Primary outcomes were late morbidity, including recurrent MU and need for additional surgical or endoscopic interventions. Secondary outcomes included early complications, changes in Body Mass Index (BMI), and nutritional parameters. Eighteen patients (median age 47.5 years, 77.8% female) underwent LGPREJ. Early complications occurred in seven patients (38.9%), including three anastomotic leaks (16.7%), all managed successfully with endoscopic or conservative therapy. No mortality occurred. Late complications affected 13 patients (72.2%), primarily anastomotic strictures (50.0%), most managed with endoscopic dilatations; two required temporary stenting. Four patients (22.2%) underwent reoperations, but only one was directly related to LGPREJ. BMI, hemoglobin, and albumin remained stable over follow-up, indicating preserved nutritional status. LGPREJ is a feasible salvage procedure for refractory MUs and other complex pouch pathologies, albeit associated with substantial morbidity. While strictures and leaks are not uncommon, they can be managed successfully without major surgery. LGPREJ should be considered a viable option in carefully selected patients.